Electrocardiographic Findings in Coronavirus Disease-19: Insights on Mortality and Underlying Myocardial Processes
Electrocardiographic Findings in Coronavirus Disease-19: Insights on Mortality and Underlying Myocardial Processes
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DOI：
10.1016/j.cardfail.2020.06.005
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发表时间：
2020-07-01
影响因子：
6
通讯作者：
Okin, Peter M.
中科院分区：
文献类型：
--
作者：
Mccullough, S. Andrew;Goyal, Parag;Okin, Peter M.
背景：冠状病毒病2019(新冠肺炎)是一种死亡率较高的呼吸综合征，需要容易获得的标志物来提供预后信息。我们试图确定入院时的心电图是否提供了预后信息，特别是与死亡相关的信息。方法和结果：我们对入院时或临近入院时有心电图的新冠肺炎患者进行了回顾性队列研究。临床特征和心电变量从电子健康记录和第一次心电中手动提取。我们的主要结果是死亡。有756名患者来到纽约市一家大型新冠肺炎教学医院接受了心电图检查。平均年龄为63.3+/-16岁，其中37%为女性，61%为非白人，57%患有高血压；90例(11.9%)死亡。在包括年龄、心电图和临床特征多因素Logistic回归中，存在一个或多个房性早搏(优势比[OR]2.57，95%可信区间[CI]1.23-5.36，P=.01)，右束支传导阻滞或室内传导阻滞(OR 2.61，95%CI 1.32-5.18，P=0.002)，缺血性T波倒置(OR 3.49，95%CI 1.56-7.80，P=0.002)，以及非特异性复极(OR 2.31，95%可信区间1.27-4.21，P=0.006)增加死亡几率。ST段抬高是罕见的(n=5[0.7%])。结论：既有左侧心脏病(房性早搏、室内传导阻滞、复极异常)，又有右侧心脏病(右束支传导阻滞)的患者死亡几率较高。导联ST段抬高是罕见的。
Background: Coronavirus disease 2019 (COVID-19) is a respiratory syndrome with high rates of mortality, and there is a need for easily obtainable markers to provide prognostic information. We sought to determine whether the electrocardiogram (ECG) on hospital presentation provides prognostic information, specifically related to death.Methods and Results: We performed a retrospective cohort study in patients with COVID-19 who had an ECG at or near hospital admission. Clinical characteristics and ECG variables were manually abstracted from the electronic health record and first ECG. Our primary outcome was death.There were: 756 patients who presented to a large New York City teaching hospital with COVID-19 who underwent an ECG. The mean age was 63.3 +/- 16 years, 37% were women, 61% of patients were nonwhite, and 57% had hypertension; 90 (11.9%) died. In a multivariable logistic regression that included age, ECG, and clinical characteristics, the presence of one or more atrial premature contractions (odds ratio [OR] 2.57, 95% confidence interval [CI] 1.23-5.36, P = .01), a right bundle branch block or intraventricular block (OR 2.61, 95% CI 1.32-5.18, P = .002), ischemic T-wave inversion (OR 3.49, 95% CI 1.56-7.80, P = .002), and nonspecific repolarization (OR 2.31, 95% CI 1.27-4.21, P = .006) increased the odds of death. ST elevation was rare (n = 5 [0.7%]).Conclusions: We found that patients with ECG findings of both left-sided heart disease (atrial premature contractions, intraventricular block, repolarization abnormalities) and right-sided disease (right bundle branch block) have higher odds of death. ST elevation at presentation was rare.